Medical Mystery Monday #103: the case of the swollen eyes

Happy Monday, everyone! Today’s mystery is another one sent in by a reader. Can you diagnose our young patient?

A 2 year old boy is brought to the pediatrician by his parents because his eyes are swollen. The child reportedly appeared normal last week, with the swelling developing over the weekend. The parents also state their son has been acting more fatigued and irritable than usual. He is otherwise healthy, was born full term, is up to date with all vaccinations, and has never been hospitalized. The child has no other symptoms and had been feeling well before this episode.

On physical exam, the patient is noted to be tired appearing. His vital signs are all normal. The boy has marked swelling of both eyelids, shown below. He also has swelling of the legs. The remainder of the physical exam is normal. The doctor orders a urine sample (shown below), which tests positive for high protein. She decides to send the child for a kidney biopsy, but the specimen appear normal under the microscope.